Patient Education

Information we provide on www.joint-docs.com and any other source or links from our site is not intended to provide medical advice. Information on this website is not a substitute for professional medical advice. Use of this site does not establish a doctor patient relationship. To diagnose or treat a health problem, for questions regarding a medical condition, or prior to starting any new treatment, you should consult with a qualified healthcare provider. For medical matters, please contact your doctor’s office by telephone. In emergency situations, call 911.

Orencia® is a medication used to treat moderate to severe rheumatoid arthritis. It is available as an intravenous infusion or a prefilled syringe. Abatacept is reserved for patients who did not respond to other medications. Abatacept is different than other biologics because it inhibits T-lymphocytes that are found in the synovial fluid. Inhibition of T lymphocytes helps reduce pain and joint inflammation.

Anakinra (Kineret) is used to treat rheumatoid arthritis, neonatal-onset multisystem inflammatory disease (NOMID), and other autoimmune diseases. It is a “biologic” medicine. This means that it is man-made through genetic-engineering techniques and closely related to a protein that occurs naturally in the body. It helps decrease inflammation in arthritis.

Anti-tumor necrosis factor (anti-TNF) drugs are a class of drugs that are used worldwide to treat inflammatory conditions such as rheumatoid arthritis (RA), psoriatic arthritis, juvenile arthritis, inflammatory bowel disease (Crohn’s and ulcerative colitis), ankylosing spondylitis and psoriasis. These drugs are able to reduce inflammation and stop disease progression.

Azathioprine (Imuran) is a drug used to suppress the immune system and help treat symptoms like joint pain and swelling in certain autoimmune conditions. The most common diseases treated with Imuran are dermatomyositis, systemic lupus erythematosus (lupus), inflammatory bowel disease and vasculitis (inflammation of the blood vessels). Azathioprine can also be used to treat rheumatoid arthritis, but it is not used as commonly as other DMARDs like methotrexate.

Azathioprine (Imuran) can be used to treat many other inflammatory conditions like inflammatory muscle diseases (dermatomyositis and polymyositis), multiple sclerosis, myasthenia gravis, autoimmune hepatitis and inflammatory bowel disease. It is also used in combination with other medications to suppress the immune system after organ transplantation to prevent rejection of transplanted organs.

Azathioprine (Imuran) belongs to a class of medications called disease-modifying antirheumatic drugs (DMARDs) or immunosuppressants. This class of medicines can decrease joint damage and disability.

Doctors use a variety of different medications to treat patients who have arthritis and other rheumatic diseases. Before any of these medicines can be prescribed, the federal Food and Drug Administration (FDA) has required strict testing to be sure they are safe and effective at treating a particular disease. Most of this testing and evaluation process is done through clinical trials.

At any given time, dozens of clinical trials conducted by licensed health care professionals are underway. These trials, lasting from a few weeks to many years, determine just how safe and effective new treatments may be. Participating in a clinical trial is completely voluntary, but it isn’t for everyone.

Source: American College of Rheumatology

Interested in Learning More About Clinical Trials at The Center for Rheumatology? Click here to learn more or call us at 518-489-4471.

Cyclophosphamide (Cytoxan) belongs to a class of drugs known as alkylating agents, which have been used to treat some types of cancer. It is also considered a potent immunosuppressant—a medicine that can decrease the immune response.

Cyclophosphamide blocks the production of the deoxyribonucleic acid (DNA) in cells. This prevents cells from dividing, leading to cell death. Some of the cells affected by this medication are immune cells. These play a key role in autoimmune diseases such as rheumatoid arthritis, lupus, scleroderma or vasculitis.

Cyclosporine (Neoral, Sandimmune, Gengraf) is a potent immunosuppressant drug that is considered a disease modifying anti-rheumatic drug (DMARD), because it not only decreases the pain and swelling of arthritis, but it may also prevent joint damage and reduce the risk of long term disability. It helps with pain and swelling and also slows the progression of arthritis over time.

Despite new and more effective treatments, many arthritis patients live with chronic pain and disability. Some people turn to herbal medicines and other "natural" remedies in the belief that they are effective and safer than conventional medications. Unfortunately, most information available to the public about these remedies in the media and on the internet is misleading. It is not based on the quality of scientific evidence required by the Food and Drug Administration (FDA) for approval of conventional medications. The purpose of this patient fact sheet is to provide you with objective, sound information so that you can make informed decisions, and to enable you to discuss with your physician the benefits and risks of natural remedies.

Hydroxychloroquine (Plaquenil) is considered a disease-modifying anti-rheumatic drug (DMARD), because it can decrease the pain and swelling of arthritis, and it may prevent joint damage and reduce the risk of long-term disability.

Joint injections or aspirations (taking fluid out of a joint) are performed in an office or hospital setting, often with a cold spray or other local anesthesia. After the skin surface is thoroughly cleaned, the joint is entered with a needle attached to a syringe. At this point, either joint fluid can be obtained (aspirated) and used for appropriate laboratory testing or medications can be injected into the joint space. This technique also applies to injections into a bursa or tendon sheath to treat bursitis and tendonitis, respectively.

Commonly injected joints include the knee, shoulder, ankle, elbow, wrist, base of the thumb and small joints of the hands and feet. Hip joint injection may require the aid of an ultrasound or X-ray called fluoroscopy for guidance. Some small joints may also be more easily aspirated or injected with aid of ultrasound.

Joint replacement surgery is typically recommended to patients who have tried non-surgical treatment but still have joint pain. While this is an extremely effective surgical treatment, total joint replacement should be considered as the last, rather than the first, treatment option for patients with advanced arthritis of the hip, knee or shoulder.

Modern joint replacement surgery involves removal of the worn cartilage from both sides of the joint, followed by resurfacing of the joint with a metal and plastic replacement implant that looks and functions much like your normal joint. Although nearly every joint in the body can be replaced, most replacement surgeries involve the hip or knee.

Over the last 30 years, improved surgical techniques and new implant materials have been developed, making total joint replacement one of the most reliable and durable procedures in any area of medicine.

Leflunomide (Arava) is a drug used approved to treat adult moderate to severe rheumatoid arthritis. It belongs to a class of medications called disease-modifying antirheumatic drugs (DMARDs). This class of medicines can decrease joint damage and disability caused by rheumatoid arthritis.

Leflunomide blocks the formation of deoxyribonucleic acid (also known as DNA), which is important for developing cells, such as those in the immune system. It suppresses your immune system to reduce inflammation that causes pain and swelling in rheumatoid arthritis. However, it is not completely clear how this medication works in rheumatoid arthritis.

Methotrexate (Rheumatrex, Trexall, Otrexup, Rasuvo) is one of the most effective and commonly used medicines in the treatment of several forms of arthritis and other rheumatic conditions. It is known as a disease-modifying anti-rheumatic drug (DMARD), because it not only decreases the pain and swelling of arthritis, but it also can decrease damage to joints and long-term disability.

Minocycline (Minocin) is an antibiotic sometimes used to treat rheumatoid arthritis (RA). It is part of the group of antibiotics known as tetracyclines. Although RA is not thought to be caused by an infection, minocycline may improve the signs and symptoms of this disease. Minocycline also belongs to the class of drugs known as DMARDs (disease-modifying anti-rheumatic drugs).

Mycophenolate Mofetil (CellCept) and Mycophenolate Sodium (Myfortic) are immunosuppressant drugs (a class of drugs that reduce the strength of the body’s immune system) used in the treatment of several autoimmune diseases. Mycophenolate was used originally in the management of patients with organ transplants, but is now recommended in the treatment of some autoimmune diseases.

Millions of Americans have arthritis and other painful health problems affecting the musculoskeletal system: the joints, muscles and bones. A mainstay of treatment for these conditions for more than three decades has been a class of medications known as nonsteroidal anti-inflammatory drugs or NSAIDs.

Traditional NSAIDs include aspirin, ibuprofen (Advil, Motrin, etc.), naproxen (e.g., Aleve) and many other generic and brand name drugs. Celecoxib (Celebrex) belongs to a newer class of NSAIDs, which doctors call a “COX-2 inhibitor” or a “COX-2 selective” NSAID.

Rituximab (Rituxan and MabThera) is a drug used to treat rheumatoid arthritis that has not improved with other types of medications, as well as certain forms of vasculitis. It works by turning off a part of the immune system that is not working properly in autoimmune diseases.

SIMPONI ARIA® (golimumab) is a prescription medicine. SIMPONI ARIA® can lower your ability to fight infections. There are reports of serious infections caused by bacteria, fungi, or viruses that have spread throughout the body, including tuberculosis (TB) and histoplasmosis. Some of these infections have been fatal. Your doctor will test you for TB before starting SIMPONI ARIA® and will closely monitor you for signs of TB during treatment. Tell your doctor if you have been in close contact with people with TB. Tell your doctor if you have been in a region (such as the Ohio and Mississippi River Valleys and the Southwest) where certain fungal infections like histoplasmosis or coccidioidomycosis are common.

STELARA® is a prescription medicine approved to treat adults 18 years and older with moderate or severe plaque psoriasis that involves large areas or many areas of their body, who may benefit from taking injections or pills (systemic therapy) or phototherapy (treatment using ultraviolet light alone or with pills).

Sulfasalazine (Azulfidine) belongs to a class of drugs called sulfa drugs and is used to treat pain and swelling in arthritis. It is a combination of salicylate (the main ingredient in aspirin) and a sulfa antibiotic. Sulfasalazine is also known as a disease modifying antirheumatic drug (DMARD), because it not only decreases the pain and swelling of arthritis, but also may prevent damage to joints. In addition, it may reduce the risk of long term loss of function.

Tocilizumab (Actemra) is a biologic drug approved to treat rheumatoid arthritis (RA) in adults and polyarticular juvenile rheumatoid arthritis (PJIA) and the systemic form of juvenile idiopathic arthritis (SJIA) in children. Biologic drugs are man-made through genetic engineering techniques and closely related to a protein that occurs naturally in the body. They are used to suppress the immune system in autoimmune disease.

Tocilizumab is used to treat inflammation. There are many pathways that can be blocked to stop the inflammation from harming the joints. Tocilizumab blocks the interleukin (IL)-6 receptor to stop the production of inflammation in the body. The medicine is injected once every 1-2 weeks or infused into your body through an IV each month.

Tofacitinib citrate (Xeljanz®) is an oral, small molecule drug used to treat adults with moderate-to-severe, active rheumatoid arthritis who have not responded well to being treated with methotrexate. Methotrexate is a disease-modifying antirheumatic drug (DMARD) used to treat rheumatoid arthritis (RA).

Tofacitinib acts to block the body’s production of enzymes called Janus kinases (JAKs). JAKs play a role in joint inflammation in RA, which can cause pain, swelling and stiffness. If left untreated, RA inflammation could lead to joint erosions, and organ and tissue damage. It may be used alone or in combination with methotrexate or other DMARDs.

Tofacitinib is currently being studied for use in treating other autoimmune diseases, including psoriasis, psoriatic arthritis, ulcerative colitis, Crohn’s disease and ankylosing spondylitis.

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I have been a patient of this practice for 28 yrs. and I feel that I am MOST fortunate to have received the very best care and treatment available. I have not enough words to express my appreciation, fondness and respect for Dr. Joel Kremer.

Dr. Toledo goes above and beyond for her patients. She treated me like a human being and not just another patient. She actually made eye contact with me, which so many other practitioners do not. I am very impressed with Dr. Toledo-Garcia!

I think Dr. Michaels is awesome. She spent so much time with me. She is really personable and not what I expected at all. Looking forward to seeing her again. I loved her tips!

I would recommend Dr. Shapiro and his nurse practitioner without any reservation whatsoever. I am extremely lucky to have Dr. Shapiro as my rheumatologist and that he has chosen over the years to continue to accept me as a patient. He is so professional, knowledgeable, trustworthy and kind.

I would recommend Dr. Hausner to anyone. She is a wonderful doctor. She listens to me and responds to my concerns/needs. She is compassionate, caring and very good at her job.

Dr. Greenstein has been my rheumatologist for 30 years. I couldn't imagine where my disease would be today without his knowledgeable, kind intervention and treatment! He literally has given me my life back.

I have been very impressed with Dr. Faisal Chaudhary. He is very knowledgeable and willing to listen to and discuss complementary strategies as well.

I have and continue to recommend your practice to anyone looking for a rheumatologist. Dr. Cavaliere is very caring and really takes the time to listen and best of all really makes appropriate changes to help my overall pain level.

I will continue to recommend your office because of my excellent visit with Rhonda Murphy, RPA and I will continue to request her. I learned so much about my different problem areas from her. She was so informative. It really was one of the best doctor visits I've ever had.

I definitely would recommend the practice. I have been seeing Mari Kaymakcian for over 3 years now and she is very thorough and understanding of my problems.

Your new office is gorgeous, accommodating and so pleasant to visit! It makes having to go to the doctor a pleasurable experience.

Dr. Cosgrove and her team give me peace of mind dealing with our medical problems in such a calm, cheerful and highly professional manner.